Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine
Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine
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DOI：
10.1111/j.1600-0412.2011.01285.x
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发表时间：
2012-02-01
影响因子：
4.3
通讯作者：
Kleiverda, Gunilla
中科院分区：
文献类型：
--
作者：
Gomperts, Rebecca;Petow, Sabine A. M.;Kleiverda, Gunilla
目标。无法利用远程医疗服务网络妇女获得安全服务的国家妇女在家医疗终止妊娠后手术干预率的影响因素分析。设计。队列研究。设置。2007年2月至2008年9月期间使用妇女网上远程医疗服务并提供后续信息的怀孕少于9周的意外怀孕妇女。样本。使用了已知随访的医疗TOP的妇女。方法。来自在线咨询、跟踪表格和电子邮件的信息被用于分析TOP的结果。主要结果测量。持续妊娠，手术原因，感知并发症及满意度。结果。在2 323名接受医学TOP且未怀孕的妇女中，289名（12.4%）接受了手术干预。高发病率见于东欧（14.8%）、拉丁美洲（14.4%）和亚洲/大洋洲（11.0%），低发病率见于西欧（5.8%）、中东（4.7%）和非洲（6.1%;p=0.000）。胎龄越长，干预越多（p=0.000）。未接受手术干预的女性对治疗的满意度更高（p=0.000）。结论。远程医疗提供的医疗TOP后报告的手术干预率的巨大地区差异不能用人口统计学因素或妊娠期长短的差异来解释。这些差异很可能反映了不同的临床实践和当地对（不完全）流产的指导方针，而不是真正需要手术干预的并发症。手术干预显著影响妇女对TOP可接受性的看法。
Objective. Analysis of factors influencing surgical intervention rate after home medical termination of pregnancy (TOP) by women in countries without access to safe services using the telemedical service Women on Web. Design. Cohort study. Setting. Women with an unwanted pregnancy less than nine weeks pregnant who used the telemedicine service of Women on Web between February 2007 and September 2008 and provided follow-up information. Sample. Women who used medical TOP with a known follow up. Methods. Information from the online consultation, follow-up form and emails was used to analyze the outcome of the TOP. Main Outcome Measures. Ongoing pregnancy, reason for surgical intervention, perceived complications and satisfaction. Results. Of the 2 323 women who did the medical TOP and had no ongoing pregnancy, 289 (12.4%) received a surgical intervention. High rates were found in Eastern Europe (14.8%), Latin America (14.4%) and Asia/Oceania (11.0%) and low rates in Western Europe (5.8%), the Middle East (4.7%) and Africa (6.1%; p=0.000). More interventions occurred with longer gestational age (p=0.000). Women without a surgical intervention more frequently reported satisfaction with the treatment (p=0.000). Conclusions. The large regional differences in the rates of reported surgical interventions after medical TOP provided by telemedicine cannot be explained by demographic factors or differences in gestational length. It is likely that these differences reflect different clinical practice and local guidelines on (incomplete) abortion rather than complications that genuinely needed surgical intervention. Surgical interventions significantly influenced womens views on the acceptability of the TOP.